Provider Demographics
NPI:1427063114
Name:MICHAEL J. KWIKER D.O. INC
Entity type:Organization
Organization Name:MICHAEL J. KWIKER D.O. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KWIKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-489-4400
Mailing Address - Street 1:3301 ALTA ARDEN EXPY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2121
Mailing Address - Country:US
Mailing Address - Phone:916-489-4400
Mailing Address - Fax:
Practice Address - Street 1:3301 ALTA ARDEN EXPY
Practice Address - Street 2:SUITE 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2121
Practice Address - Country:US
Practice Address - Phone:916-489-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA#20A-3637208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE89839Medicare UPIN
CAZZZ17757ZMedicare ID - Type Unspecified